Resident Training Level Research Articles

Use of Flexible Esophagoscopy by Otolaryngologists

We used questionnaires to determine current practice patterns for esophagoscopy by otolaryngologists in the United States, with attention to foreign body management. A 10-item questionnaire designed to determine the prevalence of flexible esophagoscopy use among otolaryngologists, with a particular focus on foreign body removal, was created and sent via e-mail to all members of the American Academy of Otolaryngology-Head and Neck Surgery. A second, 6-question survey to assess the level of resident training in flexible esophagoscopy was similarly created and sent to all directors of US otolaryngology residency programs. There were a total of 160 respondents to the first survey from all geographic regions, most of whom were in group private practice. Overall, only 21.3% of the respondents were trained to perform flexible esophagoscopy during residency, whereas 43% of those who graduated after 1990 received this training. Most respondents performed flexible esophagoscopy without sedation in the office setting. The most common indications were evaluation of dysphagia, screening for complications of laryngopharyngeal reflux, and panendoscopy for head and neck cancer. Nearly 70% of the respondents were either primarily responsible for foreign body management at their institution or shared this responsibility with a gastroenterology department. Eighty-four percent used the rigid esophagoscope alone for this purpose. More than three quarters of otolaryngology residency programs currently include flexible esophagoscopy in their training, which is performed equally in the operating room and in the office; most favor rigid esophagoscopy for foreign body retrieval but use both techniques. There has been a rapid increase in the use of flexible esophagoscopy by otolaryngologists. The majority of residency programs currently include flexible esophagoscopy in their training. Otolaryngologists play a major role in esophageal foreign body management and primarily use the rigid esophagoscope for this purpose.

Impact of Learners on Emergency Medicine Attending Physician Productivity

IntroductionSeveral prior studies have examined the impact of learners (medical students or residents) on overall emergency department (ED) flow as well as the impact of resident training level on the number of patients seen by residents per hour. No study to date has specifically examined the impact of learners on emergency medicine (EM) attending physician productivity, with regards to patients per hour (PPH). We sought to evaluate whether learners increase, decrease, or have no effect on the productivity of EM attending physicians in a teaching program with one student or resident per attending.MethodsThis was a retrospective database review of an urban, academic tertiary care center with 3 separate teams on the acute care side of the ED. Each team was staffed with one attending physician paired with either one resident, one medical student or with no learners. All shifts from July 1, 2008 to June 30, 2010 were reviewed using an electronic database. We predefined a shift as “Resident” if > 5 patients were seen by a resident, “Medical Student” if any patients were seen by a medical student, and “No Learners” if no patients were seen by a medical student or resident. Shifts were removed from analysis if more than one learner saw patients during the shift. We further stratified resident shifts by EM training level or off-service rotator. For each type of shift, the total number of patients seen by the attending physician was then divided by 8 hours (shift duration) to arrive at number of patients per hour.ResultsWe analyzed a total of 7,360 shifts with 2,778 removed due to multiple learners on a team. For the 2,199 shifts with attending physicians with no learners, the average number of PPH was 1.87(95% confidence interval [CI] 1.86,1.89). For the 514 medical student shifts, the average PPH was 1.87(95% CI 1.84,1.90), p = 0.99 compared with attending with no learner. For the 1,935 resident shifts, the average PPH was 1.99(95% CI 1.97,2.00). Compared with attending physician with no learner, attending physicians with a resident saw more PPH (1.99 vs 1.87, p<0.005). There was no statistically significant difference found between EM1: 1.98PPH, EM2: 1.99PPH, EM3: 1.99PPH, and off-service rotators: 1.99PPH.ConclusionEM attending physicians paired with a resident in a one-on-one teaching model saw statistically significantly more patients per hour (0.12 more patients per hour) than EM attending physicians alone. EM attending physicians paired with a medical student saw the same number of patients per hour compared with working alone.

A Systematic Review of Simulation in Otolaryngology Residency Training

Objectives: The central premise of our systematic review was to determine: Where does the field of otolaryngology stand in incorporating simulation into residency training? We believe there has been a profound increase in the use of simulation in otolaryngology residency training programs recently, which can be described by a simultaneous increase in the number of otolaryngology simulation-based publications. Study Design: Systematic review. Data Sources: A literature search was performed using the Ovid Medline and PubMed search engines. Methods: Two independent reviewers separately evaluated the 142 articles for relevance using specific inclusion and exclusion criteria. Results: Sixty-nine articles were included and broken down into number of publications produced per year, country of origin, resident training level targeted, the specific area being simulated, and the fidelity of the simulation. The number of simulation-based publications has increased from 1996 through 2012. The United States has produced 61% of the articles, with another 8 countries also contributing. The simulated areas were temporal bone/ear (28), airway/endoscopy (19), sinus (15), head and neck cancer (2), and esophagus (1). The fidelity of these simulations was also described as high (55 articles, 80%), low (6 articles, 9%), or both (8 articles, 11%). Conclusions: Simulation-based medical education in otolaryngology has grown tremendously since the 1990s with a corresponding increase in the number of publications. We anticipate this trend will continue, as simulation takes an increasingly important role in providing the innovative solutions to meet the challenges of training future otolaryngologists.

Emergency imaging discrepancy rates at a level 1 trauma center: identifying the most common on-call resident “misses”

The focus of our research is to identify the most frequently reported on-call discrepancies at our hospital by modality and level of resident training. Our intent is to identify specific areas of concern that may be amenable to improvement through initiation of dedicated resident training in the field of emergency radiology. Our study included 648 significant discrepancies from 193,722 studies ordered through the emergency department over a 7-year period. The overall discrepancy rates were calculated for each resident level of training and modality type. Significance was determined using χ2 testing with α = 0.05. The most common types of discrepancies were identified. The overall rate of reported discrepancies was low for all levels of training (0.23-0.42%) with a small, but statistically significant, decrease in rate for the senior residents. Common categories of discrepancies for all residents included fractures on radiographs (XR) and computed tomography (CT), masses and hemorrhage on CT, and lung nodules and pulmonary infiltrates on radiographs. Specific discrepancies reported more frequently for new call-takers included phalangeal fractures on XR as well as white matter disease, hepatic lacerations, pyelonephritis, peritoneal fluid, lymphadenopathy, and pneumothoraces on CT. It is our recommendation that radiology resident training programs ensure that the common discrepancies illustrated herein are specifically addressed as part of a dedicated emergency radiology course.

Programmatic Design for Teaching the Introductory Skills and Concepts of Lumbar Spine Procedures to Physiatry Residents

The objective of this study was to determine the effectiveness of a 2-day course teaching the introductory skills and concepts of lumbar spine procedures to physiatry residents. This is a 3-yr prospective study of a 2-day musculoskeletal course teaching the introductory skills and concepts of lumbar spinal procedures to the residents at a large academic physical medicine and rehabilitation program. The residents attending the course took multiple-choice pretests and posttests as well as participated in a procedural skills competency demonstration. Forty-two residents participated. The results were stratified according to the level of training and repetition of the material and revealed gains of medical knowledge at each level of residency training (P < 0.001). The postgraduate year 2 residents seemed to have the greatest overall improvement (P = 0.04). Half of the residents scored lower than 65% on the pretest, and these residents ultimately had the largest posttest gains. Forty (95.2%) residents achieved a grade of pass in the skills-based test. The residents felt that the course was valuable or extremely valuable. The comprehensive 2-day course teaching the skills and concepts of spinal interventions for physiatry residents enhances medical knowledge as an introduction to interventional spine care. Those who benefited the most were the residents who had the greatest deficit of medical knowledge on this topic before the course. This course curriculum does not replace fellowship training or closely monitored mentorship in the performance of spinal procedures.

116 Impact of Learners on Emergency Medicine Attending Physician Productivity

Background: Several prior studies have examined the impact of learners (medical students or residents) on overall emergency department flow as well as the impact of resident training level on the number of patients seen by residents per hour. No study to date has specifically examined the impact of learners on emergency medicine attending physician productivity, with regards to patients per hour (PPH). We sought to evaluate whether learners increase, decrease, or have no effect on the productivity of emergency medicine attending physicians in a teaching program with one student or resident per attending.

Surgical Knot Integrity: Effect of Suture Type and Caliber, and Level of Residency Training

To evaluate if suture type and caliber or level of residency training affects strength and mode of failure of surgical knots. All residents in an obstetrics and gynecology training program were invited to tie knots on a bench model using 2 calibers (0 and 3-0) of 2 types of surgical suture (polyglactin 910 and polydioxanone). The failure load, mode of failure, and loop lengths of the knots were determined. University of Texas Southwestern Medical Center, Dallas, Texas. Physicians enrolled in the University of Texas Southwestern Medical Center Obstetrics and Gynecology residency training program. Seventy-one of 73 residents participated. Knots tied with 0-caliber sutures had a higher mean failure load than those tied with 3-0 caliber sutures. For each type and caliber of suture, there were no differences in failure load between each level of residency training. However, senior residents tied knots with shorter loop lengths and had a lower proportion of knots that unraveled or slipped. Even though there were no differences in failure loads, senior residents tied tighter and more secure knots than their junior counterparts.

Does anesthesiology residency training result in decreasing intraoperative drug cost from a resident’s first to second month’s experience in adult cardiac anesthesiology?

All physicians bear the responsibility of minimizing cost while providing care that meets or exceeds national quality benchmarks. Intraoperative anesthetic drug costs constitute a small but significant fraction of the total cost in the perioperative period. Previous studies have revealed that anesthesiologists are generally unaware of drug costs. In order to determine if experience and education improve anesthetic drug cost containment, we compared the total anesthetic drug cost per case as residents progressed through their rotations in cardiac anesthesia. We considered the total anesthetic drug cost for 202 adult cardiac cases, including coronary artery bypass grafting, mitral valve repair/replacement, and aortic valve repair/replacement. 77 of the cases analyzed were done by residents in their first month of cardiac anesthesia, and 125 were done by residents in their second month of cardiac anesthesia. In the interval between these rotations, residents participate in didactics and other educational activities including a practice management rotation in the CA-3 year where they are exposed to financial topics in healthcare. The average total drug cost per case for residents in their first month was $193.50; SD= $82.00. The average total cost per case for residents in their second month was $223.30; SD=$96.10. With multivariate analysis considering case type, length of procedure and patient age, the resident training level did not impact the cost in a significant way (p=0.062). In the multivariate analysis considering case type, length of procedure and patient age, more experienced residents did not have a significantly different total drug cost per case. This finding suggests that didactic educational efforts and implicit modeling over time did not reduce drug costs in the operating room during adult cardiac surgery.

A Controlled Study to Determine Measurement Conditions Necessary for a Reliable and Valid Operative Performance Assessment

This study evaluated operative performance rating (OPR) characteristics and measurement conditions necessary for reliable and valid operative performance (OP) assessment. Operative performance is a signature surgical-practice characteristic that is not measured systematically and specifically during residency training. Expert surgeon raters from multiple institutions, blinded to resident characteristics, independently evaluated 8 open and laparoscopic OP recordings immediately after observation. A plurality of raters agreed on operative performance ratings (OPRs) for all performances. Using 10 judges adjusted for rater idiosyncrasies. Interrater agreement was similar for procedure-specific and general items. Higher post graduate year (PGY) residents received higher OPRs. Supervising-surgeon ratings averaged 0.51 points (1.2 standard deviations) above expert ratings for the same performances. OPRs have measurement properties (reliability, validity) similar to those of other well-developed performance assessments (Mini-CEX [clinical evaluation exercise], standardized patient examinations) when ratings occur immediately after observation. OPRs by blinded expert judges reflect the level of resident training and are practically significant differences as the average rating for PGY 4 residents corresponded to a "Good" performance whereas those for PGY 5 residents corresponded to a "Very Good" performance. Supervising surgeon ratings are higher than expert judge ratings reflecting the effect of interpersonal factors on supervising surgeon ratings. Use of local and national norms for interpretation of OPRs would adjust for these interpersonal factors. The OPR system provides a practical means for measuring operative performance, which is a signature characteristic of surgical practice.

The Effects of Resident Level of Training on the Rate of Pediatric Prescription Errors in an Academic Emergency Department

BackgroundMedication errors are a leading cause of increased cost and iatrogenic injury in the pediatric population. In the academic setting, studies have suggested that these increased error rates are related primarily to resident inexperience, thus advocating a higher level of supervision. Study ObjectiveWe sought to identify the number of prescription errors in our institution’s academic Emergency Department, how this varied between the beginning and end of the academic year and between practitioners at varying levels of training. MethodsA retrospective review of computer-based outpatient prescriptions for children aged 0–12 years old was performed. Outpatient prescriptions were reviewed during a 2-week time block at the end of the academic year and beginning of the academic year (109 [June] and 111 [July] data sets, respectively). Prescriptions were retrieved electronically and reviewed for appropriate dosing. Errors were defined as those that varied>10% above or below recommended weight-based dosing. ResultsTwenty-nine (16.1%) of 180 written prescription orders were determined to be incorrectly written. Error rates were not significantly different between the beginning and end of the academic year. In both sampling periods, a higher percentage were found to be derived from senior level practitioners in both data sets (9/14 and 10/15; respectively), but few of these were considered high-grade prescription errors. ConclusionsOverall prescription error rates at our institution are comparable to nationally reported error rates in children. Error rates were not associated with newly matriculated residents. These findings dispute previously held opinion that physician level of training is a factor of prescription errors.

High Fidelity Simulation Based Team Training in Urology: A Preliminary Interdisciplinary Study of Technical and Nontechnical Skills in Laparoscopic Complications Management

Simulation based team training provides an opportunity to develop interdisciplinary communication skills and address potential medical errors in a high fidelity, low stakes environment. We evaluated the implementation of a novel simulation based team training scenario and assessed the technical and nontechnical performance of urology and anesthesiology residents. Urology residents were randomly paired with anesthesiology residents to participate in a simulation based team training scenario involving the management of 2 scripted critical events during laparoscopic radical nephrectomy, including the vasovagal response to pneumoperitoneum and renal vein injury during hilar dissection. A novel kidney surgical model and a high fidelity mannequin simulator were used for the simulation. A debriefing session followed each simulation based team training scenario. Assessments of technical and nontechnical performance were made using task specific checklists and global rating scales. A total of 16 residents participated, of whom 94% rated the simulation based team training scenario as useful for communication skill training. Also, 88% of urology residents believed that the kidney surgical model was useful for technical skill training. Urology resident training level correlated with technical performance (p=0.004) and blood loss during renal vein injury management (p=0.022) but not with nontechnical performance. Anesthesia resident training level correlated with nontechnical performance (p=0.036). Urology residents consistently rated themselves higher on nontechnical performance than did faculty (p=0.033). Anesthesia residents did not differ in the self-assessment of nontechnical performance compared to faculty assessments. Residents rated the simulation based team training scenario as useful for interdisciplinary communication skill training. Urology resident training level correlated with technical performance but not with nontechnical performance. Urology residents consistently overestimated their nontechnical performance.

Simulating Laparoscopic Renal Hilar Vessel Injuries: Preliminary Evaluation of a Novel Surgical Training Model for Residents

Many surgical training programs utilize simulation-based strategies for instruction and assessment of laparoscopic skills. While the use of inanimate, animate, and virtual-reality simulation for basic or procedural skills training has been well described, the use of simulation for the purpose of training surgeons in managing intraoperative laparoscopic complications has been given less attention. We describe a novel, affordable inanimate surgical model for use in simulation-based training of laparoscopic renal hilar vessel injury management. Using a laparoscopic box trainer, a half-inch Penrose drain, standard silicone intravenous tubing, and a commercially available kidney part-task trainer, an inanimate surgical training model was developed to simulate various clinical scenarios involving renal hilar vessel injuries. To evaluate the construct validity of this training model, urology residents from the University of California, Irvine, completed a simulated scenario involving a renal vein injury (RVI) during laparoscopic radical nephrectomy (LRN). This surgical model is able to simulate both renal arterial and venous injuries during laparoscopic radical and partial nephrectomy scenarios. Initial cost to construct the model was ~800 U.S. dollars (USD) and each subsequent use was an additional 7 USD. Resident training level correlated strongly with technical performance (p<0.01) and "blood loss" (p=0.02) during the "RVI during LRN" scenario. The checklist and global rating scale used to assess performance demonstrated adequate reliability (Cronbach's α=0.82). While further validation, technical refinement, and improved fidelity are being considered, we present a novel, affordable surgical model for simulating laparoscopic renal hilar vessel injuries that is suitable for urology trainees.

Assessing Trainee Impact on Operative Time for Common General Surgical Procedures in ACS-NSQIP

To examine the effect of surgical trainee involvement on operative time for common surgical procedures. Laparoscopic appendectomy, laparoscopic cholecystectomy, and open inguinal hernia repair comprise 17.7% of the total cases sampled in the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. These cases are commonly performed by residents at varying levels of surgical training. A cross-sectional study was performed using American College of Surgeons National Surgical Quality Improvement Program data from 2005 through 2008 selecting patients undergoing laparoscopic appendectomy, laparoscopic cholecystectomy, and open inguinal hernia repair. The primary outcome was operative time and predictive variables were resident involvement and training level. Linear regression analysis was used to compare operative times between cases performed by an attending alone and those assisted by junior (postgraduate year 1-2) or senior (postgraduate year 3-5) trainees, adjusting for patient and operative factors. A total of 115,535 surgical cases were included, with 65,364 (59%) performed with junior or senior surgical residents. Resident participation was associated with higher operative times with no significant differences between the junior and senior cohorts; this effect persisted after controlling for potential confounding factors. Operative time increased by 16.6 minutes (95% confidence interval, 16.2-17.0) for junior residents and also by 16.6 minutes (95% confidence interval, 16.2-16.9) for senior residents. Surgical trainees' participation in common surgical procedures is associated with an increase in total operative time, with no difference between trainee seniority levels. This finding may be significant in assessing the impact of residency training programs on hospital efficiency.

Evaluating resident operative performance: A qualitative analysis of expert opinions

To elicit and analyze the strengths and weaknesses of resident operative performance (ROP) as identified by independent expert ratings. Four groups of expert surgeons, blinded to resident training level, evaluated ROP on 2 each of laparoscopic cholecystectomy, thyroidectomy, open inguinal, and laparoscopic ventral hernia repair audio videos, and listed strengths and weaknesses. Comments were coded as technical skills, forward planning, self-direction, situation awareness, and patient safety, and as either procedure specific or general skills. Eighteen experts independently entered 1087 comments on 8 ROP strengths and weakness. In the post independent rating discussion, consensus was reached on 85 (28%) of 300 post rating comments with majority agreement on another 83 (28%). Overall, the dominant focus was on forward planning. With the exception of the laparoscopic cholecystectomy cases, raters focused more on general than on procedure-specific skills (P < .05). Fewer than 30% of expert rater comments focused on technical skills when considering ROP strengths and weaknesses. Although there was some variation in individual comments, majority agreement was reached on 56% of comments during the post independent rating discussion. These findings will improve rater training and further the implementation of a national assessment process to evaluate end of training surgical competence and operative proficiency.

Identifying Benchmarks for Discrepancy Rates in Preliminary Interpretations Provided by Radiology Trainees at an Academic Institution

At many academic medical centers, radiology house staff provide preliminary interpretations for imaging studies after hours, the accuracy and timely availability of which are crucial to patient care. Nevertheless, these preliminary interpretations are sometimes discrepant with finalized attending reports. The rate of such discrepancies can provide valuable information for quality improvement. The aim of this study was to identify specific benchmarks for resident discrepancy rates by reviewing all 73,072 on-call reports generated at the authors' institution over 1 year. A custom-built interface called Orion was used to track all on-call reports generated in 2010. Reports graded as discrepant with major changes during attending review were automatically identified. The turnaround time (TAT) of all reports was measured. These data were used to identify specific benchmarks for resident performance on call. A total of 45,608 of 73,072 preliminary dictations (62%) were interpreted by residents; of these, 407 (0.89%) had major discrepancies. The major discrepancy rates varied among individual residents (0.2% to 1.8%), modalities, and level of resident training. On the basis of distributions, major discrepancy benchmarks were established for overall rate (1.7%) and for the modalities of conventional radiography (1.5%), CT (4.0%), and ultrasound (4.0%). The mean TAT was significantly shorter for the emergency department (46 minutes) than for inpatient services (144 minutes). A benchmark TAT of 1 hour has been adopted for all imaging studies performed through the emergency department. Identifying benchmarks for major discrepancy rates and TAT of preliminary interpretations by radiology trainees is a valuable first step for individual and departmental quality improvement.

Non-technical skills assessment in the post-operative setting

Introduction Communication failures, poor decision-making or a lack of leadership may result in negative patient outcomes in the operating room but also on the ward/emergency room setting. Assessment tools such as the Non Technical Skills for Surgeons (NOTSS), the revised Non technical Skills (NOTECHS) Scale or the Ottawa Global Rating Scale (GRS), have only been applied to operating room/critical care settings. We assessed the construct validity and inter-rater reliability of these tools in a simulated surgical ward environment. Methods Twenty surgical residents (PGY1-2) were video-recorded managing a simulated post-operative complication using a high-fidelity full body simulator in a mock surgical ward. Subjects were randomized to one of 3 scenarios (hemorrhagic shock/septic shock/pulmonary embolism). Two independent experts rated subjects' non-technical skills performance using the NOTSS, NOTECHS and Ottawa GRS. For each scale, the intra-class correlation (ICC), (two-way mixed effect, single measures) measured the inter-rater reliability and Mann-Whitney U test was compared scores across resident training level. Results Inter-rater reliability was strong for the NOTSS (ICC=0.75, p Conclusions We demonstrated the construct validity and inter-rater reliability of existing non-technical rating scales in a post-operative crisis management domain. Future surgical curricula might incorporate these scales to assess residents' non-technical skills during post-operative crisis management.

What Do Pediatric Residents Know About Malpractice?

The objective was to assess pediatric residents' attitudes toward and knowledge about medical malpractice before and after an educational intervention. A survey of pediatric residents at our academic tertiary-care center was conducted before and 6 months after an educational workshop. Of 71 eligible residents, 46 (65%) completed surveys. Thirty-nine (85%) of the 46 original participants completed the follow-up survey. At baseline, 86% thought medical malpractice should be taught during residency. This proportion increased to 95% at follow-up. At baseline, 43% reported that fear of a malpractice claim affected their practice. At follow-up, 69% indicated that fear of malpractice affected their practice (P = 0.01), and 69% of these reported improved documentation. At baseline, 30% of participants correctly thought that a resident's level of training was not a factor in determining if standard of care was provided. This increased to 56% at follow-up (P = 0.01). The majority (91%) of baseline participants thought a physician would be notified of a claim within less than 2 years of the occurrence. The actual mean delay is 25 months. At follow-up, 71% thought a physician would be notified 2 years later or more. Pediatric residents are uncomfortable with their knowledge of medical malpractice and think it should be taught during residency. Confusion regarding responsibility to provide standard of care and underestimates of the likelihood of being sued and the time to notification of a suit support the need for malpractice education. An educational intervention improves background knowledge and self-reported documentation.

A Simulation Program for Teaching Obstetrics and Gynecology Residents the Pediatric Gynecology Examination and Procedures

Study Objective To assess the use of a pelvic simulation curriculum to teach obstetrics and gynecologic residents the pediatric gynecology examination and procedures. Design Residents in obstetrics and gynecology participated in a simulation curriculum using a modified pelvic hemimodel to simulate a pediatric pelvis. Participants 19 obstetrics and gynecology residents completed the study protocol. Interventions Digitally recorded encounters with a standardized patient scenario using the simulator were utilized. After the initial encounter the trainees participated in a formal lecture and demonstration using the model. The trainees were then reassessed at least four weeks after the initial encounter; results were reviewed by a blinded evaluator. Scores were analyzed using the two-sided t-test and Wilcoxon signed-rank test. Main Outcome Measures Scores from before to after the simulation training. Results A total of 19 residents completed the study protocol and demonstrated significant improvement in scores from before to after the simulation training. Scores improved from a pre-training mean of 6.1 to post-training mean of 16.7 ( P = 0.0001). Improvement was seen at all levels of residency training. Specific skill sets included in the Council for Resident Education in Obstetrics and Gynecology (CREOG) Educational objectives (1) were improved including: pediatric gynecologic examination, collection of microbial cultures, vaginal lavage and vaginoscopy. Conclusions This teaching program using a simulation model was found to be an effective tool to improve resident knowledge and performance of the skills needed to accomplish the pediatric gynecology examination.

Improving Education under Work-Hour Restrictions: Comparing Learning and Teaching Preferences of Faculty, Residents, and Students

Faced with work-hour restrictions, educators are mandated to improve the efficiency of resident and medical student education. Few studies have assessed learning styles in medicine; none have compared teaching and learning preferences. Validated tools exist to study these deficiencies. Kolb describes 4 learning styles: converging (practical), diverging (imaginative), assimilating (inductive), and accommodating (active). Grasha Teaching Styles are categorized into "clusters": 1 (teacher-centered, knowledge acquisition), 2 (teacher-centered, role modeling), 3 (student-centered, problem-solving), and 4 (student-centered, facilitative). Kolb's Learning Style Inventory (HayGroup, Philadelphia, Pennsylvania) and Grasha-Riechmann's TSS were administered to surgical faculty (n = 61), residents (n = 96), and medical students (n = 183) at a tertiary academic medical center, after informed consent was obtained (IRB # 06-0612). Statistical analysis was performed using χ(2) and Fisher exact tests. Surgical residents preferred active learning (p = 0.053), whereas faculty preferred reflective learning (p < 0.01). As a result of a comparison of teaching preferences, although both groups preferred student-centered, facilitative teaching, faculty preferred teacher-centered, role-modeling instruction (p = 0.02) more often. Residents had no dominant teaching style more often than surgical faculty (p = 0.01). Medical students preferred converging learning (42%) and cluster 4 teaching (35%). Statistical significance was unchanged when corrected for gender, resident training level, and subspecialization. Significant differences exist between faculty and residents in both learning and teaching preferences; this finding suggests inefficiency in resident education, as previous research suggests that learning styles parallel teaching styles. Absence of a predominant teaching style in residents suggests these individuals are learning to be teachers. The adaptation of faculty teaching methods to account for variations in resident learning styles may promote a better learning environment and more efficient faculty-resident interaction. Additional, multi-institutional studies using these tools are needed to elucidate these findings fully.

309: The Effects of Resident Matriculation and Level of Training on the Rate of Pediatric Prescription Errors In the Emergency Department

309: The Effects of Resident Matriculation and Level of Training on the Rate of Pediatric Prescription Errors In the Emergency Department